Narrative Skills in Young Adults With High-Functioning Autism Spectrum Disorders

Abstract

In this study, the author investigated narrative performances of 10 high-functioning young adults with Autism Spectrum Disorders (ASD) across personal and storybook narratives. Narratives were elicited with genre-specific procedures and then transcribed and scored using the narrative scoring scheme (NSS). One-tailed paired-sample t tests were conducted on four variables, for which the standard mean difference between the genres (NSS Total Score, Introduction, Conclusion, and Mental States) was large. To avoid inflating Type I error, an alpha of .012 was set. Results indicated that, on average, high-functioning adults with ASD had poorer quality personal narratives for NSS Total Score, Mental States, and Conclusion. This suggests that many high-functioning adults with ASD have difficulty in expressing how they feel and often neglect to conclude and make sense of their experiences in a social context. Telling personal narratives is an important skill for high-functioning adults with ASD because narratives support social interaction and relationships.

Keywords

high-functioning Autism Spectrum Disorders pragmatics narrative

Introduction

Challenges with social communication are a core defining feature of individuals with Autism Spectrum Disorders (ASD), which is the new classification of the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-V; American Psychiatric Association, 2013) for individuals with Autism and Asperger Syndrome. This classification collapses previously distinct subtypes into one unified category. Social communication abilities among persons with ASD have been found to vary greatly. High-functioning individuals with ASD often exhibit well-developed phonology, vocabulary, and grammar, yet have difficulty with the pragmatics of language (Tager-Flusberg, Paul, & Lord, 2005). Many adolescents and adults with ASD report that their difficulties with the pragmatic conventions of the mainstream culture are one of the most stigmatizing and debilitating aspects of their ASD. These problems, in turn, cause difficulties in initiating and maintaining relationships with others, which often result in feelings of anxiety, isolation, or depression (Landa, 2000; Lord & Ward, 1993; Paul & Wilson, 2009).

People participate in narratives on a daily basis from a very young age (Berman, 2009). Narrative is classified within pragmatics as a branch of linguistics that recognizes the role of context and inferred intention. The analysis of narrative discourse is considered a valid method for analyzing pragmatic skill because the analysis moves beyond the sentential level and provides a functional evaluation of social communication and cognition (De Villiers, 2005; Van Dijk, 2011). Delivery of a successful narrative requires the ability to (a) organize one’s thoughts and experiences using causal-explanatory relationships (Peterson & McCabe, 1983); (b) understand one’s own social, cultural, and emotional perspectives and that of others in a variety of contexts (Bruner, 1986); (c) evaluate what information is needed by the listener to form a shared frame of reference; (d) monitor and adjust the style and content of the interaction based on the listener’s reactions; and (e) integrate all of these tasks to produce a cohesive and compelling account or exchange (Karmiloff-Smith, 1985; Peterson & McCabe, 1983). These features make narratives a natural means by which to analyze and evaluate the integration of a wide variety of linguistic and social-cognitive knowledge (Botting, 2002; Young, Diehl, Morris, Hyman, & Bennetto, 2005).

People engage in various genres of narratives, such as fictional narratives (e.g., storybook or fantasy narratives) and personal event narratives. Personal narratives are found in the everyday conversations of young children and adults (McCabe, Bliss, Barra, & Bennett, 2008). They are an important way that individuals, from as young as 2 years of age, encode knowledge of their intentional states (Bruner, 1986), make meaning of their own life experiences (Bruner, 1986; McCabe, 1996; Ochs, 2004), and establish and sustain social relationships (McCabe, 1996; Ochs, 2004). Fictional narratives, in comparison, are often told in the school setting and are a strong predictor of academic achievement and school success (Petersen, Gillam, Spencer, & Gillam, 2010; Snow, Burns, & Griffin, 1998). Furthermore, the prominent role of fictional narratives in core educational standards across grade levels speaks to their practical significance in preparing students for college (National Governors Association Center for Best Practices & Council of Chief State School Officers, 2010; Petersen et al., 2010).

Both personal and fictional narratives have been analyzed at the microstructural and macrostructural levels (Heilmann, Miller, Nockerts, & Dunaway, 2010; Justice et al., 2006). Microstructural analyses focus on productivity (e.g., number of clauses, number of words) and complexity of syntactic organization (Justice et al., 2006). In contrast, macrostructural analyses focus on the overall organization of the narrative (Heilmann et al., 2010; Justice et al., 2006). While a variety of ways to analyze narrative macrostructure exist, most schemes are based on either “story-grammar” (Stein & Glenn, 1979) or “high-point” (Labov, 1972) analyses. Researchers also have analyzed narratives with regard to the presence of literate language, which is the ability to use abstract or decontextualized language (Curenton & Justice, 2004; Heilmann et al., 2010) and to provide cohesion (Halliday & Hasan, 1976). Through words that link other linguistic expressions, such as the use of causal and temporal connectors and referential expressions, cohesion creates unity in a story. Some researchers classify cohesion at the level of microstructure (Justice et al., 2006), while others classify it at the level of macrostructure (Heilmann et al., 2010).

The majority of studies on narratives in individuals with ASD have analyzed children’s storybook narratives. Results from high-functioning children found no significant differences, compared with neurotypical controls, on measures of length (Diehl, Bennetto, & Young, 2006; Young et al., 2005), syntactic complexity (Diehl et al., 2006; Losh & Capps, 2006; Young et al., 2005), the amount of evaluation (Norbury & Bishop, 2003), the range of evaluative devices (Losh & Capps, 2006), or completeness of episodes and story grammar (Norbury & Bishop, 2003; Young et al., 2005). Significant differences were, however, noted on measures of coherence (Diehl et al., 2006) and referential expression (Norbury & Bishop, 2003).

Losh and Capps (2006) compared both storybook and personal narratives of high-functioning children with ASD to the narratives of neurotypical peers. They found the telling of storybook narratives by high-functioning children to be more similar to that of controls than did the telling of personal narratives. Causal explanations, however, were an area of difficulty for the children with ASD in both narrative genres. Goldman (2008) also compared the personal narratives of high-functioning children with ASD with those of neurotypical peers. Using a high-point analysis for macrostructure, she found that only the personal narratives of the children with ASD lacked the climactic event (i.e., the high point) and that they neglected to discuss a resolution.

Only two studies were found that analyze narratives in high-functioning adults. Colle, Baron-Cohen, Wheelwright, and van der Lely (2008) analyzed storybook narratives and found no significant differences in the frequency of mental state terms or in story grammar between high-functioning adults with ASD and neurotypical peers. Differences were found on measures of coherence and referential expression. McCabe, Hillier, and Shapiro (2012) analyzed personal narratives and found that high-functioning adults with ASD performed similarly to neurotypical controls on both number of words used and sentence complexity. In contrast, the overall macrostructure of their narratives was, on average, less mature. Unlike neurotypical peers, few young adults with high-functioning ASD resolved their personal narratives. These results are striking because neurotypical children have been shown to be able to add a resolution by 6 years of age (McCabe & Peterson, 1991; Peterson & McCabe, 1983).

Taken together, the literature on narratives for high-functioning individuals with ASD suggests that performance in both storybook and personal narratives was similar to that of controls on measures of microstructure, with the exception of cohesion, for which the individuals performed worse than controls in both genres. In contrast, the literature suggests that children and adults with high-functioning ASD performed differently across the two narrative genres in terms of macrostructure. That is, they performed more similarly to controls with respect to macrostructure when telling storybook narratives than when telling personal narratives. It is noteworthy that storybook narratives were analyzed using a story-grammar approach, whereas three of the four studies on personal narratives used a high-point analysis. Story-grammar and high-point analyses focus on different aspects of what constitutes a good narrative (Peterson & McCabe, 1983). Story-grammar analysis focuses on cognitive problem solving and concerns the narrator’s articulating how the protagonist responds to an event and sets up a goal or a plan to achieve the goal (Peterson & McCabe, 1983). High-point analysis, in comparison, concentrates on personal experiences and the narrator’s attitudes toward the events of the narrative (McCabe & Peterson, 1984; Peterson & McCabe, 1983). Despite these differences, story-grammar and high-point analyses yield very similar results in terms of overall narrative sophistication (McCabe & Peterson, 1984). This suggests that the differences in the macrostructure found in studies of high-functioning individuals with ASD are not related to the method of analyses but, rather, to differences in genre (storybook vs. personal narrative).

Purpose of the Study

The purpose of this pilot study was to investigate narrative performances in high-functioning young adults with ASD across two narrative genres, storybook narratives and personal event narratives, using the same method of analyses. To this end, we collected personal event narratives and storybook narratives from 10 high-functioning young adults with ASD. Narratives from both genres were scored using the narrative scoring scheme (NSS; Heilmann et al., 2010). NSS yields both a holistic score and several dimensional scores that include measures of macrostructure and coherence. Two research questions were explored as follows:

Research Question 1. What type of differences do high-functioning young adults with ASD exhibit in overall narrative performances between storybook retell and personal event narratives?

Research Question 2. What are the patterns of strengths and weaknesses in narrative performances of high-functioning young adults with ASD across the two narrative genres?

Based on previous studies, the author predicted that high-functioning young adults with ASD would have more difficulty with the macrostructure of personal event narratives (Goldman, 2008; McCabe et al., 2012) as compared with storybook narratives (Colle et al., 2008; Norbury & Bishop, 2003; Young et al., 2005) but would perform similarly on measures of coherence and referential expression across both genres (Losh & Capps, 2006).

Method

Participants

Participants included nine males and one female high-functioning young adults with ASD (M_age = 24.59 years, SD_age = 2.25 years, range = 22–28 years). Participants were recruited from a university collaborative database of adults with ASD. The collaborative was established to ensure that database participants were not given the same assessments by different researchers. The Wechsler Abbreviated Scale of Intelligence (WASI; Wechsler, 1999) and Module 4 of the Autism Diagnostic Observation Scales (ADOS; Lord, Rutter, DiLavore, & Risi, 2002) were administered to participants within 3 months of the start of the study by psychologists credentialed with research-reliability on the ADOS. Participants were monolingual English speakers, with a WASI full scale IQ ≥ 90 (M = 111.40, SD = 8.48, range = 99–125) and ADOS scores that qualified them as having ASD using the criteria of a Communication score ≥ 2, a Social Interaction score ≥ 4 and the combination of the two scores ≥ 7 (M_{Communication} = 3.2, SD_{Communication} = .83, range = 2–5; M_{Social Interaction} = 6, SD_{Social Interaction} = 2, range = 2–4; and M_cumulative = 9.2, SD_cumulative = 2.2, range = 7–14). Three of the participants attended a local university. Two of the university participants were undergraduates and lived at home with their parents, and the third was a doctoral student who lived independently in an apartment. The other seven participants were enrolled in a computer-training program for individuals with high-functioning ASD and lived in an on-campus apartment with on-site support available. All participants agreed to participate in this study and underwent an informed consent procedure approved by the university’s institutional review board.

Procedure

The following procedures were approved by the university’s institutional review board. A trained research assistant collected narratives in a quiet room at a location convenient for the participant. The protocol consisted of the research assistant’s eliciting at least three personal narratives, one storybook narrative, using the book Frog, Where Are You? by Mercer Mayer (1969), that is, Frog Story (SALT Software, n.d.), and a fable comprehension task that is not reported here. For both narrative genres, neutral responses were used to encourage narration without directing it (e.g., “uh huh, tell me more”). The sessions were videotaped for subsequent transcription and analyses. Frog, Where Are You? was chosen because it is a wordless picture book well established in the research literature on narrative discourse. Despite the Frog Story’s childlike qualities, it is considered appropriate for use with adults (Reese, 2013). Frog Stories have been used with adults to understand (a) the developmental characteristics of narrative in native English speakers (Bamberg, 1987; Bamberg & Damrad-Frye, 1991); (b) the psychology of language using a cross-linguistic approach (Bavin, 2009; De Leon, 2009; Kuntay & Kochas, 2009); and (c) the characteristics of narrative in adults who are learning English (Kang, 2004). In addition, the Frog Story has been used extensively in the narrative literature on high-functioning children with ASD (Diehl et al., 2006; Losh & Capps, 2006; Norbury & Bishop, 2003; Young et al., 2005), high-functioning young adults with ASD (Colle et al., 2008), and young adults with Fragile X Syndrome (Finestack, Palmer, & Abbeduto, 2012). The Frog Story requires the narrator to shift from one character to another, which is difficult for individuals with ASD, but the ease of the story does not stress participants with comprehension demands, memory load, or concept/vocabulary knowledge (Colle et al., 2008). The Frog Story was elicited using the procedures outlined by Miller and Iglesias (2010). Specifically, participants first listened to an audio recording of the Frog Story through headphones while looking at the book. Next they were asked to look at the pictures and to retell the story to the examiner.

Personal event narratives were elicited using the conversational map procedure (McCabe & Rollins, 1994) for the collection of personal narratives. Specifically, the examiner elicited at least three different narratives by first telling a brief narrative (i.e., a story prompt). The story prompts used in this study were based on McCabe and Bliss’s (2003) list of adult prompts (e.g., being in an accident on the way to the appointment, getting hurt, having something stolen, losing a pet). Story prompts were inserted before and between tasks to help maintain a natural flow of conversation. Because persons of all ages tend to tell narratives in everyday conversation about situations that are unusual or problematic in some way, all prompts used disturbing or challenging experiences (Bruner & Feldman, 1994; McCabe, 1996; Ochs, 2004). To help control for individual differences in interest and experience, the conversational map procedure stipulates the analysis of only the most complex narratives. Therefore, multiple narratives were elicited from each participant (M = 3.7, SD = 0.78, range = 3–5). To identify each participant’s most complex personal narrative, all personal narratives were scored with the 7-point high-point scale used by McCabe et al. (2012). Each participant’s most complex personal narrative, as determined by high-point analysis, was used in the final analyses.

Transcription

Narratives were transcribed onto computer files and formatted following the conventions of the Systematic Analysis of Language Transcripts (SALT; Miller & Iglesias, 2010). All narratives were transcribed into a standard measure of utterance length called a communication unit (C-unit). C-units are independent clauses and their modifiers.

Narrative Analyses

NSS is a holistic scoring method that provides an index of the ability to produce a coherent narrative. Because NSS is a developmentally sensitive measure that can be used with different genres of narrative (Heilmann et al., 2010), it was used to analyze narrative structure. NSS uses a 0- to 5-point scale for each of seven dimensions: (1) Introduction, (2) Conflict Resolution (i.e., existence of conflicts and how they are resolved), (3) Conclusion, (4) Character Development, (5) Mental States (i.e., the amount and type of vocabulary that are used to describe the characters’ thoughts and feelings), (6) Referencing (i.e., consistent and appropriate use of antecedents and clarifiers), and (7) Cohesion (i.e., appropriate sequencing, details, and transitions throughout the narrative). A score of 5 indicates proficient; 3, emerging/inconsistent; and 1, immature or minimal. Narratives of neurotypical adults would fall into the somewhat proficient to proficient range (4–5).

The dimension scores are summed together to create the NSS total score (maximum = 35), which serves as a holistic impression of the narrative. Specifically, Introduction, Conflict Resolution, and Conclusion concern the key components of story grammar, whereas Referencing and Cohesion indicate the overall coherence of the narrative. Character Development and Mental States refer to the use of a literate style.

Reliability

Of the narratives, 20% were randomly selected and independently transcribed and coded by a research assistant and the author. Point-by-point agreement was 97% for high-point analyses and 90% for NSS coding. Disagreements were resolved by consensus.

Results

Table 1 presents the descriptive statistics for the NSS total score and for each of the dimensional scores for personal narratives and Frog Stories. The high-functioning young adults with ASD varied on all narrative components in both genres; however, the standard deviations (and ranges) were larger for personal narratives than for Frog Story narratives, with the exception of Referencing. The young adults’ performance on personal narratives ranged from 1 to 5 (i.e., minimal to proficient) across the seven narrative dimensions. In contrast, performance on Frog Stories ranged from 3 to 5 (i.e., emerging to proficient) on story-grammar components, 2–4 and 2–5 (i.e., a little better than minimal to nearly proficient or proficient) on literate language components, 1–5 (i.e., minimal to proficient) on Referencing, and 3–4 (i.e., emerging to nearly proficient) on Cohesion.

Table 1.

Descriptive Statistics for NSS Total and Dimensional Scores Across Two Genres (N = 10).

	Personal narrative		Frog story
Characteristic	M (SD)	Minimum, Maximum	M (SD)	Min, Max	95% CI	d
NSS total score	20.00 (3.77)	12, 26	25.30 (3.43)	19, 31	[−9.25, −1.35]	1.47
Introduction	3.30 (1.34)	1, 5	4.00 (0.67)	3, 5	[−1.82, 0.42]	0.69
Conflict resolution	3.30 (1.25)	1, 5	3.80 (0.79)	3, 5	[−1.68, 0.68]	0.48
Conclusion	1.80 (1.14)	1, 4	3.50 (0.71)	3, 5	[−2.71, −0.67]	1.80
Character development	3.20 (1.55)	1, 5	3.50 (0.71)	2, 4	[−1.26, 0.66]	0.25
Mental states	2.50 (1.27)	1, 5	4.00 (1.05)	2, 5	[−2.73, −0.27]	1.12
Referencing	2.70 (1.25)	1, 4	2.90 (1.37)	1, 5	[1.14, −0.34]	0.15
Cohesion	3.20 (1.14)	1, 5	3.60 (0.52)	3, 4	[−1.37, 0.57]	0.45

Note. NSS dimension scores (1 = minimal, 3 = emerging, 5 = proficient), CI = confidence interval of the mean difference, d = standardized mean difference, a standardized measure of the magnitude of the effect that is not reliant on sample size (d = 0–0.2 is a small effect; 0.3–0.5, a medium effect; and 0.5–0.8, a large effect). NSS = Narrative Scoring Scheme.

Table 1 also displays the confidence intervals for the mean difference between personal narratives and Frog Stories as well as Cohen’s d, a standardized measure (i.e., measured in standard deviation units) of the magnitude of the effect that is not reliant on sample size; for this study, it is the standardized mean difference between the genres (see Note 1). Cohen’s d is a measure of effect size or practical importance of the difference between personal narratives and Frog Story narratives for each variable. Cohen’s (1988) interpretation is that a d of 0–0.2 is a small effect; 0.3–0.5, a medium effect; and 0.5–0.8, a large effect. Accordingly, the total NSS score (d = 1.47) and the story-grammar components of Introduction (d = 0.67) and Conclusion (d = 1.80) as well as the character development component of Mental States (d = 1.12) all have very large effect sizes.

To be judicious with the number of significance tests performed in this exploratory study with a small sample size, the authors conducted one-tailed paired t tests only on the four measures that had a large effect size. In addition, to avoid inflating Type I error (i.e., rejecting the null hypothesis when it is true) from 5% to 18%, we used an a priori alpha of .012 (i.e., .05/4). We found that the NSS of the holistic impression score of the narrative, t(9) = −3.04, p = .007, the story-grammar component of Conclusion, t(9) = −3.79, p = .002, and the Mental States score, t(9) = −2.76, p = .011, were, on average, lower when personal event narratives, as compared with storybook narratives, were told. We could not reject our null hypothesis for the story-grammar component of Introduction, t(9) = −1.41, p = .10. Finally, we predicted that high-functioning individuals with ASD would perform similarly on measures of Referencing and Cohesion across genres. This was substantiated by the very small Cohen’s d, which suggested that the observed difference between personal and storybook narratives for Referencing and Cohesion was inconsequential.

Discussion

In this pilot study, the author compared personal narratives and storybook narratives of high-functioning young adults with ASD. The holistic impression, as indexed by the NSS total score, was less favorable for personal narratives than for storybook narratives. The very large effect size associated with the NSS total score suggests that not only was this finding statistically significant but also that the difference would be easily detected by a listener. Furthermore, we found differences between the two genres on the story-grammar component of Conclusion and on the use of Mental State words. That is, many high-functioning young adults with ASD had minimal skill in describing how they felt about the events in their lives and in reaching a conclusion about these events, even though they were proficient at these same skills when retelling a fictitious story. The latter finding is consistent with that of McCabe et al. (2012). Also consistent with the literature were the similarities in Referencing and Cohesion across narrative genres. Thus, our findings are consistent with those of Losh and Capps (2006), who found that, while high-functioning children with ASD demonstrated similar difficulties in causal cohesion across the narrative genre, their storybook narratives appeared more typical than did their personal narratives.

Two weakness of this study are the very small sample size and the lack of a neurotypical control group; therefore, the results should be interpreted with caution. The effect sizes were large, however, and the statistically significant results were consistent with previous research. In addition, narrative performance was analyzed using a developmentally sensitive criterion reference measure (Heilmann et al., 2010), and neurotypical adults are expected to have proficient narratives in both genres. Therefore, these preliminary findings suggest the need for additional research on personal narratives in individuals with ASD using a more rigorous design that allows for a comparison of participants’ performances with those of neurotypical adults.

In the current study, we compared personal narratives with storybook narratives using a similar methodology. Storybook narratives are important for school-aged children due to their relationship with literacy skills and academic achievement (Petersen et al., 2010); however, these narrative skills may not generalize to daily conversation (Losh & Capps, 2006). In comparison, personal narratives are prevalent in daily conversations outside the classroom or laboratory (McCabe et al., 2008) and are relevant in the lives of adults. Personal narratives require the dynamic telling of a narrative in a social context. They are a universal means to bring the past into the present, help make sense of experiences, and form relationships (McCabe, 1996; Nelson & Fivush, 2004).

Research on personal narratives in high-functioning children and adults with ASD has the potential to help characterize the diversity in this important form of discourse. Supporters of the neurodiversity movement advocate reconceptualizing ASD as a natural variation rather than a disorder (Walsh, Elsabbagh, Bolton, & Singh, 2011). High-functioning adults with ASD have many intellectual strengths and talents and should be viewed as having differences that require social acceptance and support (Jaarsma & Welin, 2012). For example, college campuses are seeing an increased prevalence of incoming students with ASD and must work to improve support systems to facilitate inclusion and social acceptance (Wolf, Brown, & Bork, 2009). Acceptance in a neurotypical-centric world requires interaction between the personal characteristics of individuals with ASD (including their narrative style) and the characteristics of the society in which they live (Wolf et al., 2009). As we have shown, the telling of personal narratives is considerably difficult for many high-functioning individuals with ASD. They may have problems reframing everyday experiences into stories that decode these experiences (Bruner & Feldman, 1994; McCabe et al., 2012). Understanding the personal narrative skills of high-functioning adults with ASD has the potential to contribute to neurotypical peers’ compassion and acceptance of diverse discourse styles as well as to contribute to the development of self-advocacy skills for persons on the spectrum.

Diversity in personal narratives also may be a consequence of the social-linguistic milieu of young children with ASD. Individual differences in caregivers’ styles of structuring conversations about past experiences with young neurotypical children affects how these children develop narrative skills during their preschool years and beyond (McCabe & Peterson, 1991). Unlike neurotypical children, children with ASD may not have rich experiences from a young age of co-constructing non-present and past event narratives with their caregivers. Most current therapy approaches for young children with ASD do not focus on co-constructing personal narratives or discerning one’s own emotions about events (Bruner & Feldman, 1994; Rollins, 2014). In contrast, storybook narratives are part of the academic curriculum. Thus, it is possible that differences in early social exchanges may, in part, contribute to the differences that some high-functioning individuals with ASD exhibit when telling personal narratives as adolescents and adults.

Telling personal narratives about one’s life is an important skill for individuals on and off the autism spectrum. Personal narratives support social interaction, engagement, and relationships, which are core challenges for individuals with ASD. While this is an exploratory pilot study, the large effect sizes associated with the author’s findings suggest that research on personal narratives may show promise in understanding the diversity of social communication in high-functioning adults with ASD.

Footnotes

Acknowledgements

The author would like to thank the young adults who participated in this study; Lauren Brockman, Joshua Weatherly, Amanda Blackwell, and Erin Wallach for assistance with collecting and coding the data; and an anonymous reviewer.

Authors’ Note

This project has received Institutional Review Board (IRB) approval (IRB 08-27) from the University of Texas at Dallas. A portion of this data was presented at the 2012 ASHA convention.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was partially supported by a University of Texas at Dallas (UTD) School of Behavioral and Brain Sciences Faculty Initiative Award and Callier Center Excellence in Education Award to the author.

Notes

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